We Have the Best Brains but No Equipment – JUTH JOHESU Chair

Adams Ebuga is the Chairman of the Joint Health Sector Union (JOHESU), Jos University Teaching Hospital (JUTH). Also the Chairman of the Non-Academic Staff Union of JUTH, he has been in the news lately, especially towards the end of the year 2021. In this interview with Ralph Madugu, he spoke on the running battle between his unions and JUTH management prior to the end of the tenure of the immediate past Chief Medical Director and other sundry matters

The name Adams Ebuga has been in the news lately especially towards the end of 2021. Briefly tell us about yourself.

I am the JOHESU Branch Chairman at JUTH and also the NASU Chairman JUTH. As you know, before you head JOHESU, you must belong to one of the sub-unions and my background is NASU and I have spent a year and some months now as the Chairman of JOHESU.

Why did you caution the Federal Government against the planned privatization of the health sector?

Now, first of all, if public hospitals are to be privatized, it means the common man will suffer from such a policy. Take for example, what is obtainable now in private hospitals in this country. If you go to a private hospital, to open a card will cost you 5,000 naira or more. That is just to open a card. In some other private hospitals, it is as high as 10,000 naira just to see a doctor. Now, if these public hospitals that are being run without this high cost are privatized, you can imagine what will be the fate of the ordinary man out there who is just looking for succor.

And I believe that healthcare provision is the primary responsibility of every government because the people pay tax and what are these taxes supposed to be used for? They are for social amenities which government is supposed to provide for each and every individual so that they can have some form of succor.  But if they are privatized now, then it means they are going to be run like private hospitals!  Then it means that the average Nigerian cannot afford basic Healthcare services; which is also a basic necessity. That’s the angle we are looking at it basically.

Looking at privatization, you find out that the public sector tends to function better when it is privatized. What is your take on this?

I don’t really believe that, except as we have cautioned earlier. It is about the issue of round pegs in round holes. Now, what has been happening to the government’s health sector is the fact that people are given leadership positions not based on their capability to perform but on the basis of ‘man-know-man’. And these appointees run government with an I don’t care attitude because it is government. But in the private sector, the mindset is different which can also be brought into the government establishments for effective results. It is about the mindset.

If privatization would benefit the common man, would you still insist that it should not be done?

What I believe is that government hospitals can also be jacked up. If our mindset can be corrected to address the attitudinal problems, I can guarantee you that government hospitals will compete with their private counterparts in terms of service delivery at a very minimal cost.

You are advocating that government hospitals should be manned by administrators. What is the motivation behind this?

We have people that are trained as hospital administrators. These are people trained to handle hospitals administratively because a doctor’s primary responsibility is to treat a patient. Yes, some of them will say they open private hospitals and they are doing well. But when you look at the complexity of what they are handling, it is not as large as a Teaching Hospital where you have as many as 3000 to 4000 staff. You can’t compare it with a private hospital that has 20 to 30 patients. The number is minimal. The demands are different. The scope is different and what you are dealing with is minimal. If you look at Hospital Management, it is purely an administrative work that requires people who are trained as administrators.

Following the expiration of the tenure of the immediate past Chief Medical Director of Jos University Teaching Hospital, JOHESU members embarked on wild jubilation, carrying placards with various inscriptions. Tell us what prompted such celebration.

Prior to that time, when you enter JUTH, what you would see on the faces of JUTH staff was sadness because the working environment wasn’t actually conducive. Everything was just crumbling. Talking about consumables, patients had to buy everything they are supposed to be treated with: you buy hand gloves, you buy syringes, you buy cotton wool in a Teaching Hospital which is not supposed to be so! And then people had their entitlements withheld, people were not paid for overtime they do, outside staff were being owed for 30 months. JUTH had series of litigations in court with management.

This has never happened before. This is not the first time we are having a Chief Medical Director (CMD), but if you look at it, the situation had never been this bad. JUTH staff were just anxiously waiting for the expiration of his tenure to now breathe a sigh of relief. So, as soon as the news broke out that the CMD has actually handed over to the next person as Acting-CMD, then wild jubilation went all over the hospital premises. And that is to tell you how people were happy. Before then, staff barely came to work. The jubilation for us was a sign of relief and we can now begin to think positively and expect the best from the staff. Whatever position you’re given, you must understand that it is about the people!

Are you saying that there was no delegation of responsibilities by the ex-CMD?

To a large extent, there was not, because for things to go wrong under your nose, then it means there is a problem. You can fire anybody that fails to carry out your directives. Do you understand? As the head, you delegate somebody to do something and if the person does not do it, what is your own responsibility? Is it to caution the person or fire the person? When that is not happening, then it means the head is lacking and there is no wisdom.

How was the relationship between the former CMD, the Management of the hospital and the Union?

Well, for us we can say that there hasn’t been a rosy relationship since he came on board. Before he came on board, we had been having a very good relationship with the past CMDs. There were areas of disagreements, there were times we sat on a round table. But the last one came and worsened everything! Right now we are in court with the management over our two months’ salaries that were withheld.

What was the basis for withholding the salaries?

We went on a strike because the hospital was without consumables, nothing was happening in the hospital which is a tertiary hospital. Once a patient is brought in, you can’t give him your best because a lot of things were not on ground. So staff went on strike for two months. The case was eventually resolved in Abuja and there was a signed agreement that we call off the strike, go back to work and everything will be looked into and resolved. There was a clause at the end of the agreement which says that staff will not be victimized. But he hurriedly ran to the Minister and said that no-work-no-pay should be applied. So he got that letter before that agreement was signed only for him to come and apply the no-work-no-pay and we said No. There is a clause in our agreement which says there won’t be any victimization but he was holding to the fact that there was a letter that came and we are saying no after the letter we went to Abuja with him and in the presence of the Minister an agreement was signed but he insisted he is not going to pay us, there was nothing we didn’t do as a Union but he said over his death body to pay that money.

We came back and said, look, the money that will be spent on this case doesn’t make sense. Let us sit down and resolve this thing, let him shift ground and we too will shift ground because it cannot be a winner take all but he refused. Then we said that the court should decide.

Aside the one you mentioned, are there other litigations?

There are. There is a case between the medical and laboratory scientist and the management which is currently ongoing. There is also a case between management and the defunct JUTH FC and then there are individual cases against the JUTH management and it is the same lawyer that is handling all these cases. It means anytime the lawyer appears in court over a case, JUTH as an institution pays him N2.5 million naira. So, imagine if the lawyer appears two or three times in court over some of these cases, calculate the total amount the lawyer is paid at the end of the month. Meanwhile, workers are owed 30 months’ salaries. And these owed salaries are being budgeted for. But the money you are paying as appearance fee to lawyers is not budgeted for. So, it means you are taking money meant for the running of the hospital to service litigations. This shows that we have a managerial problem. We have never had it this bad. It is only during his 8 years, six months’ reign that we had all these cases in court. We told him that look, things are happening in JUTH and you keep complaining that there is no money, let us see how we can withdraw some of these litigations from the court and settle them amicably because it saves you as Management and save us as a Union but he said No!

Now, in the course of his 8 years what suggestions did JOHESU give to ensure that things got better?

We held series of meetings with the management. There is this misconception people tend to have about unionism, thinking that the union leaders are always after what benefits them alone. But that is not the case. We are a catalyst for progress. We checkmate, to a large extent, the excesses of the executive and ensure that things are moving well, that staff are given their dues and they (staff) in turn also put in their best. This is because we have to work for what we are being paid for. This is the attitude that is required. To a large extent, it is the union leaders that drive the process. If you go to organizations where there is a cordial working relationship between the management and the union, you will see how they are collectively working for the same goal.

In fact, during the tenure of the former CMD, Dr. Ishaya Pam, there was a year that a national strike was declared but we said, look, we have a very good working relationship with the management and we stood our ground that we will not embark on strike. So, we had to explain and convinced our national leadership, telling them that JUTH management has been giving us all the needed support and cooperation hence we needed to reciprocate that. They understood with us and we didn’t go on strike. People may say that during Prof. Banwat’s time, we did not go on strike, we said since there are options, let us explore other avenues so that it shouldn’t be strike all the time. We should dialogue and we had dialogue sessions. We held meetings upon meetings. We had confrontations with management but all of these did not yield anything positive or tangible.

You were specifically quoted saying as, “It was only God that kept us for these eight years during his tenure as CMD and that in the last eight years you experienced a scenario where a referral hospital was now referring patients to private hospitals for various tests and diagnoses because machines and other equipment are broken down or non-functional.” Give us specific instances.

What I meant by saying it was God that kept us going was because it was during his tenure that we were teargassed at the gate while protesting because things were not working well and we draw the attention of the public and the Federal Government on the need to come and salvage JUTH. On that fateful day, we were there at the gate and the next thing we saw was a truck of armed policemen inside the premises of the hospital (our working place) and they started shooting at us with teargas. It was God, I tell you, that helped us that day. We could have had serious casualties that day. Some of our members were actually rushed to the casualty and, of course, some members were injured. It was also during his time that we had the highest rate of staff mortality almost every month as a result of frustration. The record is there. We have never had it so bad. When you have high rate of high blood pressure, what does that indicate? It is psychological issues…you have house rent to pay yet your salary is being withheld. How do you cope?

On the issue of referral centre, there were so many tests that JUTH was supposed to carry out. Take for instance, x-ray. Towards the end of last year (2021), all the machines were down. You go to see a doctor, he recommends an x-ray for you, you have to go outside the hospital and look for a place to do it. You want to do MRI test, the machine is down, you have to go outside. You want to do some basic laboratory tests, you have to go out and run those tests outside.

Remember, these are things that you are supposed to do in JUTH but you must go outside. That’s referral! We had cases where patients themselves, because of one issue or the other, had to go out there. These are problems that any serious management should be able look into. We are a union and we will be ready to put all the happenings behind us. And that is why we are promising management that this year (2022), if things are going to be put in the right perspective, we are giving them our total support and cooperation. We are not against the management. We are here to ensure that management discharges its own responsibilities while staff too, do their own.

What are some of the mechanism put in place by JOHESU to check the attitude of staff to work?

We have started addressing our members on lateness to work, effective and efficient service delivery to our patients because we cannot afford to compromise these things. Now that we have a new CMD, we are approaching this year with new vigor.  One other area that I must commend the management about is the fact that we have applied for a bus and they graciously granted it to us. This will address the issue of mobility of staff while coming to work and returning home after work.

How would you describe the general state of tertiary health institutions in the country?

You see, the truth is that we have the best brains but the problem is that we work without equipment. That is basically our problem here. Looking at it from the medical to non-medical sector, we have good brains but the working condition is something else. Most of our machines are almost becoming obsolete and technology evolves every day. So, what government ought to do is to ensure that our tertiary hospitals, amongst other healthcare institutions in the country, are equipped with the state-of-the-art facilities. It will interest you to know that healthcare systems in other countries are now tourist attractions.

What is your message to the new acting CMD, having enumerated the challenges you encountered with the immediate past CMD?

Thank God, he is not coming from outside JUTH. He is somebody who has been part of us, working and witnessing all what I have told you. Our call and prayer for him is that he should apply wisdom. I know his passion. His passion is to see that JUTH competes with any best private hospital you can think of in rendering effective service delivery. He should get his feedback mechanism in place and take advantage of the management session and ensure that issues are tackled within the shortest possible time. All we want is somebody that can move JUTH forward and restore its lost glory.

You have been advocating for an administrator and now you have a medical doctor as CMD in acting capacity. What is your take on that?

When I said that we prefer an administrator, I ended by saying that even if they are bringing somebody, let it be someone that is knowledgeable in administration, someone who knows leadership, someone who has the leadership qualities and potentials. There are medical doctors that know only their profession. There are others who take extra time to study or learn administration. It works in two ways. Even if they can’t get this one, they will get that other one. There is no contradiction whatsoever here.